Epinephrine versus norepinephrine

The choice of vasopressor is always a topic of controversy regarding post cardiac arrest patients. Intensive Care Medicine recently published an article with focus on “Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock”. This study was in Paris metropolitan region. They included 766 patients and they found using Epi in OHCA post cardiac […]

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Double Sequential Defibrillation, Yay or Nay!

When we published our review “The controversial role of dual sequential defibrillation in shockable cardiac arrest”, our conclusions was further studies are necessary to assess the efficacy and safety of DSD compared to the standard of care treating refractory VF. AEM published another study exactly one year later: Prehospital Double Sequential Defibrillation: A Matched Case-Control […]

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Calcium Channel Blocker or Adenosine for SVT

I had  a patient with perisstent Supraventricular tachycardia (SVT). My approach usually starts with REVERT, and if unsuccessful will continue with Adenosine. Adensoine with its rapid onset, and short half-life regardless of teribble expeince for patient is a great medication, but in this particular patient in 2 occasions was converting SVT to Sinus rhythm and after […]

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The Canadian Syncope Arrhythmia Risk Score

Another Canadian risk score published in AEM, discussing Short-term Risk of Arrhythmia among Patients With Syncope. This is a multicenter prospective cohort study with 5,010 patients. This study had very good sensitivity: 97% and very poor specificity 53%. Please take a look at the study for 39 different variables that they considered. Link to Abstract

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Chest pain and ACS

One of our favorite question in ED is: “Does this patient with chest pain have ACS?” JAMA in Nov. 2015 tried to answer this question from the eyes of cardiologist in ED! Patient presented to ED with chest pain evaluated from 1995 to 2015. History, physical exam, ECG, clinical decision rule and Troponin were examined […]

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EKG and PE!

I cannot say that  we did not know about this, but having an article to support this is very exciting. Jeff Kline and his colleagues analyzed 45 studies of 8,209 patients and found the most EKG findings among patients whom was diagnosed with acute PE: tachycardia (38%), T-wave inversion in lead V1 (38%), and ST […]

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Epinephrine in OHCA!

We discussed 2 studies in our class specific session on impact of EPi on out of hospital cardiac arrest. J Am Coll Cardiol published another study  this month and challenged again use of Epi in OHCA. 1,556 patients from 2000 to 2012, using EPi with different doses, and the conclusion is  pre-hospital use of epinephrine […]

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aVR: The most Ignored Lead

JACC in 2001 published an article that nicely explained the necessity of interpreting lead aVR in clinical setting. There are 3 categorizes that we should consider in this regard:1. acute coronary syndromes, 2. acute PE, 3. arrhythmia. I strongly recommend you to take a look to the following link JACC article

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Hypertension treatment

What is your favorite hypertension numbers to treat in ED? there are a lots of controversies regarding the exact number to start treatment in ED but recent Cochrane review on mild HTN suggest that antihypertensive agents used in the treatment of adults with hypertension stage I (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg)

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SYNCOPE vs Near SYNCOPE

I read this article long time ago but I had a discussion with one of my resident and to give her reference I would like to have it here. Basically this study showed that Syncope and Near syncope has same critical interventions or adverse outcomes. This term should be taking care as we care about […]

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New Concepts in the Assessment of Syncope

There is a State-of-the-Art Paper in the latest edition of Journal of the American College of Cardiology, May 2012.The title of article is New Concepts in the Assessment of Syncope. The authors perspective was based on the presence of a syncope specialist (“the right physician”), adequate equipment including online prompting tools and logistics (“the right […]

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